Organization
SHEA CLINIC
Active
Other names
Shea Clinic, ASC
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN R GROSS (ADMINISTRATOR)
(901) 761-9720
Entity
Organization
Contact information
Practice address
6133 POPLAR PIKE, MEMPHIS, TN 38119-4707
(901) 761-9720
(901) 683-8440
Mailing address
PO BOX 17987, MEMPHIS, TN 38187-0987
(901) 761-9720
(901) 683-8440
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
0000000050
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
490000678
RAILROAD MEDICARE
TN
Enumeration date
04/19/2006
Last updated
10/21/2010
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